Early Superimposed NMES Training is Effective to Improve Strength and Function Following ACL Reconstruction with Hamstring Graft regardless of Tendon Regeneration.

The study aimed at investigating the effects of neuromuscular electrical stimulation superimposed on functional exercises (NMES+) early after anterior cruciate ligament reconstruction (ACLr) with hamstring graft, on muscle strength, knee function, and morphology of thigh muscles and harvested tendons. Thirty-four participants were randomly allocated to either NMES+ group, who received standard rehabilitation with additional NMES of knee flexor and extensor muscles, superimposed on functional movements, or to a control group, who received no additional training (NAT) to traditional rehabilitation. Participants were assessed 15 (T1), 30 (T2), 60 (T3), 90 (T4) and at a mean of 380 days (T5) after ACLr. Knee strength of flexors and extensors was measured at T3, T4 and T5. Lower limb loading asymmetry was measured during a sit-to-stand-to-sit movement at T1, T2, T3, T4 and T5, and a countermovement-jump at T4 and T5. An MRI was performed at T5 to assess morphology of thigh muscles and regeneration of the harvested tendons. NMES+ showed higher muscle strength for the hamstrings (T4, T5) and the quadriceps (T3, T4, T5), higher loading symmetry during stand-to-sit (T2, T3, T4, T5), sit-to-stand (T3, T4) and countermovement-jump (T5) than NAT. No differences were found between-groups for morphology of muscles and tendons, nor in regeneration of harvested tendons. NMES+ early after ACLr with hamstring graft improves muscle strength and knee function in the short- and long-term after surgery, regardless of tendon regeneration.

Monitoring Training Load in Soccer: The ROMEI Model.

ABSTRACT: Montini, M and Rocchi, JE. Monitoring training load in soccer: The Relation of Ongoing Monitored Exercise in Individual model. J Strength Cond Res 36(9): 2566-2572, 2022. For a training organization, monitoring training load (TL) is of paramount importance. Despite this, a conclusive response on such topic is yet to be reported. The aims of this study were to investigate the relationship between TL indicators and to propose a new method for monitoring TL response and physical fitness. Twenty professional soccer players were retrospectively evaluated. The first phase of data analysis included 34 in-season training sessions. Subsequently, three microcycles (T1-T2-T3) of pre-season training were processed. A regression model was used to examine the relationships between internal TL (session rating of perceived exertion [s-RPE]) and external TL (energy expenditure, EE). The standard error of the regression equation was used to propose a new model called "ROMEI" (Relation of Ongoing Monitored Exercise in Individual). The level of statistical significance was set at p < 0.05. During the competitive season and the pre-season training camp, the average TL values were 65.8 ± 22 and 58.2 ± 22 minutes; 336 ± 204 and 228 ± 101 AU of s-RPE; and 29 ± 13 and 25 ± 9 kJ kJ -1 of EE, respectively. In the competitive season, the collective and average individual correlation coefficients between s-RPE and EE were r = 0.888 and r = 0.892 ± 0.05, respectively. Considering slope values ( m ) of the regression line, data highlighted a significant increase of +34.4 ± 15.9% in T2 vs. T3 ( p < 0.001) and +38.2 ± 15.2% in T1 vs. T3 ( p < 0.001). Data shown in this investigation support the use of an individualized analysis to better understand the TL administered to soccer players rather than a collective analysis. This may be accomplished with the proposed ROMEI model.

No Relationship Between Preoperative and Early Postoperative Strength After ACL Reconstruction.

CONTEXT: All rehabilitative programs before anterior cruciate ligament (ACL) reconstructive surgery, which are focused on recovery of proprioception and muscular strength, are defined as prehabilitation. While it has shown that prehabilitation positively affects the overall outcome after ACL reconstruction, it is still controversial whether preoperatively enhancing quadriceps strength has some beneficial effect on postoperative strength, mainly during the first period. OBJECTIVE: To determine whether there is any relationship between preoperative and early postoperative quadriceps strength. DESIGN: Case control. SETTING: University research laboratory. PARTICIPANTS: Fifty-nine males (18-33 y; age: 23.69 [0.71] y) who underwent ACL reconstruction with patellar-tendon autograft were examined the day before surgery, and at 60 and 90 days after surgery. MAIN OUTCOME MEASURES: The limb symmetry index (LSI) was quantified for maximal voluntary isometric contraction of the knee extensor muscles and of the knee flexor muscles at 90° joint angle. A k-means analysis was performed on either quadriceps or hamstrings LSI before surgery to classify the patients in high and low preoperative LSI clusters. Differences in postoperative LSI were then evaluated between the high and low preoperative LSI clusters. RESULTS: Following surgery, there were no differences in the quadriceps LSI between patients with high and low preoperative quadriceps LSI. Sixty days after surgery, the hamstrings LSI was higher in patients with high than low preoperative hamstrings LSI (84.0 [13.0]% vs 75.4 [15.9]%; P < .05). CONCLUSIONS: Findings suggest that quadriceps strength deficit is related to the ACL injury and increases further after the reconstruction without any correlation between the preoperative and postoperative values. Therefore, it appears that there is no need to delay surgery in order to increase the preoperative quadriceps strength before surgery.